Provider Demographics
NPI:1396616918
Name:PEREZ MEDINA, ILIA ENID (PHARMD)
Entity type:Individual
Prefix:
First Name:ILIA
Middle Name:ENID
Last Name:PEREZ MEDINA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6020 AVE ROBERTO SANCHEZ VILELLA
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00982-3707
Mailing Address - Country:US
Mailing Address - Phone:787-759-4162
Mailing Address - Fax:
Practice Address - Street 1:6020 AVE ROBERTO SANCHEZ VILELLA
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00982-3707
Practice Address - Country:US
Practice Address - Phone:787-759-4162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-16
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6206183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty